Health Plans - UK-HMO and UK-RHP
At a glance: UK-HMO and UK-RHP (Regional Health Plan, formerly UK-HMO RSA) offer quality care through UK HealthCare facilities and physicians (UK-HMO) or other participating providers (UK-RHP). These plans offer the lowest monthly premiums and lowest out-of-pocket costs. No deductible. No out-of-network coverage.
For complete details on the UK UK-HMO plan, click here. To find out if a provider is a available under the UK-HMO plan, visit our Web site at www.mc.uky.edu/ukhmo). To search for a primary care physicians, visit this page.
To view complete plan details on the UK-RHP plan, click here. Coverage is provided for emergency care at a non-participating facility only if your condition is an Emergency Medical Condition as determined by the plan.
UK-HMO Summary of Health Plan Benefits
The UK-HMO offers an excellent value for your premium dollar. There are no deductibles to meet and no copayments for routine physicals or well child care when services are provided by a network primary care physician.
UK-HMO Factors to Consider:
- Lexington Service Area network consists of UK HealthCare facilities (including Chandler Hospital, Good Samaritan Hospital, and Kentucky Clinics) and UK HealthCare physicians.
- Regional Health Plan Area network includes the UK HealthCare facilities, UK HealthCare physicians and select Humana/ChoiceCare providers (use the UKHMO RSA provider link on the Humana page).
- No referrals are required for specialty care services provided within the network.
- No deductibles to meet.
- No coverage for out-of-network services unless it is life or limb threatening.
- Covered transplants include kidney, liver, pancreas, kidney/pancreas, heart, lung, heart/lung, bone marrow and cornea transplants.
Prior authorization is required for the following services:
Durable medical equipment (over $750), home health care and hospice services
and other services as listed in the certificate of coverage. Available urgent care options include: Urgent Treatment Centers in Lexington (Dove Run Road, Custer Drive, and Boardwalk Street), Nicholasville (Bellaire Drive) as well as the UK Children's Twilight Clinic.
UK-HMO and UK-RHP Summary of Health Plan Benefits
2012-2013
|
Major Plan Benefits
|
Benefits for Covered Services Provided at Participating Providers |
Lifetime Maximum Benefit |
|
Unlimited |
Copayment Limits |
Individual and Family |
N/A |
Preventive Care
|
Routine Pap smears, mammograms, PSA, screening colonoscopy and sigmoidoscopy |
100%
|
Physician Services
|
Office visits (excludes certain diagnostic lab and X-ray) |
100% after $10 copayment for primary care physician, |
Lab tests, X-rays and diagnostic tests |
100% |
|
Allergy injections |
100% after $10 copayment |
|
Inpatient services |
100% |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
100% after $200 copayment per admission |
Organ transplants |
100% |
|
Outpatient surgery |
100% after $75 copayment |
|
| Emergent/Urgent Services | Emergency Room
Urgent Treatment Center
UK Children's Twilight Clinic |
100% after $100 copayment (waived if admitted) 100% after $25 copayment 100% after $15 copayment |
Other Medical Services
|
Skilled nursing facility (up to 30 days per plan year) & Hospice Services |
100% |
Home health care (up to 60 visits per plan year) |
80% |
|
Durable medical equipment, orthotics and prosthetics |
80%, maximum member responsibility of $500/plan year for all services combined |
|
Hearing aids |
$1,400 benefit every 36 months for children under 18 |
|
Speech therapy, pulmonary rehab therapy, physical, occupational therapy, cardiac rehab, manipulative therapy, hydrotherapy and acupuncture therapy (limited to 45 visits per plan year, combined)
|
100% after $15 copayment per visit for all therapies |
|
Mental Health and Substance Abuse |
Inpatient mental health or substance abuse |
100% after $200 copayment per admission |
Outpatient mental health or substance abuse |
100% after $30 copayment
|